Uprise EHR & PM Blog



2 Misconceptions and 5 Hard Facts about ICD-10 and Claims Management

Posted by Janelle Pauli on Jun 1, 2015 10:00:00 AM

As much as you want to be prepared for ICD-10, we want to help you get there. And, with all of the buzz floating around about the impending switch to ICD-10 you can't help but start to feel a little bit anxious, and maybe even a little worried, about if your practice can handle the claims management change.

We're here to tell you that it's really not as huge of a deal as it has been made out to be. You deal with changes and updates in your office on a daily basis, and this is just one more change that you and your staff will have to adjust to. To help put your mind at ease, here are a few interesting numbers about converting codes from ICD-9 to ICD-10:

24% of codes are an exact match
49% of codes are an approximate match
19% of codes are a match with 1 choice
2% of codes are a match with multiple choices
2% of codes have no match
4% of codes have one to many matches
Almost 75% of the codes are going to be an exact or approximate match to the current ICD-9 code that you're already using. Hopefully that makes the switch to ICD-10 sound a little less intimidating. Let's take a look at 2 common misconceptions, and 5 hard facts from the CMS to get your practice prepared for the change.

2 Common ICD-10 Misconceptions

Preparing for ICD-10 is a Clerical FunctionICD-10 Claims Management

It's really more of a documentation function. If the OD is doing their part to correctly document each patient, then the biller is going to have an easier time translating the documentation into the specific ICD-10 code.

Your EHR will Take Care of Everything

Your EHR software is definitely going to help you out when it comes to ICD-10, but by no means is it going to take care of it all. You have to get in the habit of entering the right documentation for each exam at a specific enough level so that your system can help provide you with the right code.

5 Hard Facts

The Change is Coming on 10.01.2015

In the past this date has a history of being postponed, but this is likely going to be it. So, don't sit back and assume that the date will change. Start preparing now!

There are 68,000 Codes

This is true. But what's not true is that you're going to have to use all 68,000 of them. Does your practice currently use all 13,000 ICD-9 codes? Absolutely not. Since you're specialized in Optometry you know you'll only be using a smaller, specific set of codes.

Looking Up Codes is Going to be Similar

Just because there are more codes, doesn't necessarily mean that it's going to be more complicated. You'll have plenty of help looking up new codes from an alphabetic index to electronic tools that can help you find the code that you need.

Outpatient and Office Procedures will be the Same

The change is happening with diagnosis codes and inpatient procedure codes, but you will continue to use CPT for outpatient and office coding.

Medicare Fee-for-Service Prodivers will Have the Opportunity to Conduct Testing with the CMS

Either your practice or clearinghouse can conduct acknowledgement testing at any time with your Medicare Administrative Contractor.

If you are looking for more information to get your practice prepared for the ICD-10 transition check out the CMS website, or subscribe to our blog!

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